Pub Date : 2025-12-24DOI: 10.1016/j.clnesp.2025.102888
Junhong Su , Guorong Ma , Xianghua Tang , Zhongren Ma , Zhenrong Xie , Maikel P. Peppelenbosch
Background
Our previous studies show that the improvement in cardiometabolic traits by intermittent fasting is associated with remodeling the gut microbiome, with short-chain fatty acids (SCFA) producing bacteria being evident. These effects, however, are largely lost when intermittent fasting is discontinued. Konjac mannan oligosaccharides (KMOS) are a commercial nature-deprived prebiotic, which has been reported to increase the levels of intestinal SCFA-producing bacteria. However, the capacity of continued KMOS consumption to maintain intermittent fasting-provoked levels of SCFA-producing bacteria, remains unknown.
Methods
This study aims to test whether a KMOS supplement positively affects fasting-provoked SCFA-producing bacteria levels during, and in particularly, after discontinuation of intermittent fasting. This prospective, randomized, controlled trial will be conducted in overweight volunteers aged 18–65. All participants will perform one month of intermittent fasting followed by one month of an ad libitum diet. Participants will be randomly assigned to receive KMOS (1.5 g/d) during fasting, both during fasting and the subsequent ad libitum period, or neither. Primary outcomes will be relative abundance of SCFA-producing bacteria in fecal samples, as determined by 16s rRNA sequencing. Secondary outcomes will be changes in body weight, blood pressure, and serum lipid levels.
Conclusions
Findings from this trial will answer the question whether KMOS can maintain fasting-associated SCFA producer level and metabolic benefits when fasting is discontinued.
{"title":"Konjac mannan oligosaccharides as a sustainer of fasting-associated gut microbiome signature after discontinuation of intermittent fasting in overweight individuals: A protocol for an open-label randomized clinical trial","authors":"Junhong Su , Guorong Ma , Xianghua Tang , Zhongren Ma , Zhenrong Xie , Maikel P. Peppelenbosch","doi":"10.1016/j.clnesp.2025.102888","DOIUrl":"10.1016/j.clnesp.2025.102888","url":null,"abstract":"<div><h3>Background</h3><div>Our previous studies show that the improvement in cardiometabolic traits by intermittent fasting is associated with remodeling the gut microbiome, with short-chain fatty acids (SCFA) producing bacteria being evident. These effects, however, are largely lost when intermittent fasting is discontinued. Konjac mannan oligosaccharides (KMOS) are a commercial nature-deprived prebiotic, which has been reported to increase the levels of intestinal SCFA-producing bacteria. However, the capacity of continued KMOS consumption to maintain intermittent fasting-provoked levels of SCFA-producing bacteria, remains unknown.</div></div><div><h3>Methods</h3><div>This study aims to test whether a KMOS supplement positively affects fasting-provoked SCFA-producing bacteria levels during, and in particularly, after discontinuation of intermittent fasting. This prospective, randomized, controlled trial will be conducted in overweight volunteers aged 18–65. All participants will perform one month of intermittent fasting followed by one month of an <em>ad libitum</em> diet. Participants will be randomly assigned to receive KMOS (1.5 g/d) during fasting, both during fasting and the subsequent <em>ad libitum</em> period, or neither. Primary outcomes will be relative abundance of SCFA-producing bacteria in fecal samples, as determined by 16s rRNA sequencing. Secondary outcomes will be changes in body weight, blood pressure, and serum lipid levels.</div></div><div><h3>Conclusions</h3><div>Findings from this trial will answer the question whether KMOS can maintain fasting-associated SCFA producer level and metabolic benefits when fasting is discontinued.</div></div><div><h3>Clinical trial registration</h3><div>ChiCTR2200058139.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102888"},"PeriodicalIF":2.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-20DOI: 10.1016/j.clnesp.2025.102883
George Samoutis , Tassos C. Kyriakides , Nicholas Demetriou , Evdoxia Poulianiti , Gregoria Samouti , Sophronia Samouti , Panagiotis Diamantakos , Eleni Melliou , Prokopios Magiatis
<div><h3>Background & aims</h3><div>Olive oil aldehydic phenols (OOPs), including oleocanthal, oleacein, oleuropein aglycone, and ligstroside aglycone, are highly bioactive secoiridoids with unique health-protective properties. Preclinical investigations have demonstrated that OOPs possess anti-inflammatory and antioxidant attributes. The aim of the study was to assess the direct health properties of OOPs as a food supplement in humans diagnosed with metabolic syndrome. Fasting Blood Glucose (FBG) and Hemoglobin A1c (HbA1c) were chosen as primary endpoints because they are key indicators of glucose control, a core aspect of metabolic syndrome. Their combined assessment offers a comprehensive view of both short-term and long-term glucose regulation, making them highly relevant for evaluating interventions.</div></div><div><h3>Methods</h3><div>This double-blind, randomized, controlled clinical trial screened 110 individuals for eligibility between September 16, 2024, and January 27, 2025. Eight did not meet the inclusion criteria for metabolic syndrome, and 102 eligible participants were randomly assigned to the OOPs supplement or placebo group using a computer-generated randomization sequence to receive either the OOPs supplement or placebo. The 12-week intervention provided either a 10 mg/day polyphenol-rich olive oil extract food supplement (80 % oleocanthal/oleacein, 18 % oleuropein aglycon/ligstroside aglycon) or a placebo. No changes to lifestyle were recommended, and diet and physical activity were assessed at week 6. Fasting blood glucose (FBG) and hemoglobin A1C (HbA1c) were the primary outcomes. Secondary outcomes included lipid profile, C-reactive protein (CRP), body mass index (BMI), blood pressure, waist circumference, liver function tests (LFTs), estimated glomerular filtration rate (eGFR), uric acid, and fatigue scores. Repeated measures ANOVA/Linear Mixed Models were used to compare the mean changes (12 weeks-baseline) in fasting blood glucose levels between the intervention group and the placebo arm. Similar analysis (changes since baseline) was conducted for the continuous secondary outcomes. For categorical outcomes, changes since baseline were compared using chi-square methods. Bonferroni adjustments were made for multiple comparisons as appropriate.</div></div><div><h3>Results</h3><div>All 102 randomized participants completed the 12-week intervention and were included in the final analysis. The intervention group demonstrated significant improvements across various metabolic and physiological markers compared to the placebo group. Notable reductions were observed in FBG (mean difference: −7.06 mg/dL, p < 0.0001) and HbA1c (−0.29 %, p < 0.0001). Additionally, the intervention led to significant decreases in BMI (−1.15, p < 0.0001), systolic blood pressure (−7.66 mmHg, p = 0.004), triglycerides (−8.57, p = 0.0003), oxidized LDL (−5.01, p < 0.0001), uric acid (−1.04, p < 0.0001), ALT (−4.92, p = 0.0002), and fa
{"title":"The impact of olive oil polyphenol supplementation on metabolic syndrome parameters The OleoMetS study: A randomized, controlled clinical trial","authors":"George Samoutis , Tassos C. Kyriakides , Nicholas Demetriou , Evdoxia Poulianiti , Gregoria Samouti , Sophronia Samouti , Panagiotis Diamantakos , Eleni Melliou , Prokopios Magiatis","doi":"10.1016/j.clnesp.2025.102883","DOIUrl":"10.1016/j.clnesp.2025.102883","url":null,"abstract":"<div><h3>Background & aims</h3><div>Olive oil aldehydic phenols (OOPs), including oleocanthal, oleacein, oleuropein aglycone, and ligstroside aglycone, are highly bioactive secoiridoids with unique health-protective properties. Preclinical investigations have demonstrated that OOPs possess anti-inflammatory and antioxidant attributes. The aim of the study was to assess the direct health properties of OOPs as a food supplement in humans diagnosed with metabolic syndrome. Fasting Blood Glucose (FBG) and Hemoglobin A1c (HbA1c) were chosen as primary endpoints because they are key indicators of glucose control, a core aspect of metabolic syndrome. Their combined assessment offers a comprehensive view of both short-term and long-term glucose regulation, making them highly relevant for evaluating interventions.</div></div><div><h3>Methods</h3><div>This double-blind, randomized, controlled clinical trial screened 110 individuals for eligibility between September 16, 2024, and January 27, 2025. Eight did not meet the inclusion criteria for metabolic syndrome, and 102 eligible participants were randomly assigned to the OOPs supplement or placebo group using a computer-generated randomization sequence to receive either the OOPs supplement or placebo. The 12-week intervention provided either a 10 mg/day polyphenol-rich olive oil extract food supplement (80 % oleocanthal/oleacein, 18 % oleuropein aglycon/ligstroside aglycon) or a placebo. No changes to lifestyle were recommended, and diet and physical activity were assessed at week 6. Fasting blood glucose (FBG) and hemoglobin A1C (HbA1c) were the primary outcomes. Secondary outcomes included lipid profile, C-reactive protein (CRP), body mass index (BMI), blood pressure, waist circumference, liver function tests (LFTs), estimated glomerular filtration rate (eGFR), uric acid, and fatigue scores. Repeated measures ANOVA/Linear Mixed Models were used to compare the mean changes (12 weeks-baseline) in fasting blood glucose levels between the intervention group and the placebo arm. Similar analysis (changes since baseline) was conducted for the continuous secondary outcomes. For categorical outcomes, changes since baseline were compared using chi-square methods. Bonferroni adjustments were made for multiple comparisons as appropriate.</div></div><div><h3>Results</h3><div>All 102 randomized participants completed the 12-week intervention and were included in the final analysis. The intervention group demonstrated significant improvements across various metabolic and physiological markers compared to the placebo group. Notable reductions were observed in FBG (mean difference: −7.06 mg/dL, p < 0.0001) and HbA1c (−0.29 %, p < 0.0001). Additionally, the intervention led to significant decreases in BMI (−1.15, p < 0.0001), systolic blood pressure (−7.66 mmHg, p = 0.004), triglycerides (−8.57, p = 0.0003), oxidized LDL (−5.01, p < 0.0001), uric acid (−1.04, p < 0.0001), ALT (−4.92, p = 0.0002), and fa","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102883"},"PeriodicalIF":2.6,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.clnesp.2025.102881
Pedro Batista Castro , Heitor Soares Brandão , Glauco Martins de Araujo , Gustavo Procópio Silva , Luísa Gonçalves Carvalho , Palle Bekker Jeppesen , Samuel I. dos Santos Pereira
Background & aims
The efficacy of glucagon-like peptide-2 (GLP-2) analogues in patients with short bowel syndrome (SBS) with intestinal failure (IF) is not well established. We aimed to compare the efficacy of GLP-2 analogues relative to placebo in patients with SBS dependent on parenteral support (PS).
Methods
PubMed, Embase, and Cochrane Central were searched from inception to April 15, 2025 for randomized controlled trials (RCTs) comparing GLP-2 analogues with placebo in patients with SBS. Endpoints included change in weekly PS volume, clinical response, enteral autonomy, and ≥1-day/week PS reduction. Pooled risk ratios (RRs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models. SMD was used due to differences in reporting units (mL/day vs. L/week).
Results
We included 283 patients from 4 RCTs, including one crossover trial; 188 (66.4%) received GLP-2 analogues. Weekly absolute PS volume reduction was significantly greater with GLP-2 analogues than with placebo (SMD −0.54; 95% CI −0.71 to −0.36; p = 0.0022; I2 = 0%), with consistent results in a sensitivity analysis restricted to week 24. There were no significant differences in clinical response (RR 1.94; 95% CI 0.57 to 6.56; p = 0.1453; I2 = 23.7%) and enteral autonomy (RR 4.21; 95% CI 0.00 to 280351.17; p = 0.3479; I2 = 0%) between groups. Clinical response was defined as achieving a ≥20% reduction in weekly PS volume from baseline sustained through weeks 20 and 24. Reduction in PS by ≥ 1 day/week was more frequent with GLP-2 analogues (RR 2.27; 95% CI 1.59 to 3.26; p = 0.0219; I2 = 0%).
Conclusion
This meta-analysis of 4 RCTs including 283 patients showed that GLP-2 analogues significantly reduced weekly PS volume and more often achieved ≥1-day/week reductions in PS compared with placebo, with no significant differences in enteral autonomy or clinical response.
背景与目的：胰高血糖素样肽-2 （GLP-2）类似物对短肠综合征（SBS）合并肠衰竭（IF）患者的疗效尚不明确。我们的目的是比较GLP-2类似物相对于安慰剂对依赖肠外支持（PS）的SBS患者的疗效。方法：检索PubMed， Embase和Cochrane Central从成立到2025年4月15日的随机对照试验（rct），比较GLP-2类似物与安慰剂在SBS患者中的作用。终点包括每周PS量的变化、临床反应、肠内自主性和≥1天/周PS减少。采用随机效应模型计算合并风险比（rr）和95%置信区间（ci）的标准化平均差（SMDs）。由于报告单位（mL/天vs. L/周）的差异，使用了SMD。结果：我们纳入了来自4项随机对照试验的283例患者，包括1项交叉试验；188例（66.4%）接受GLP-2类似物治疗。GLP-2类似物的每周绝对PS体积减少明显大于安慰剂（SMD -0.54; 95% CI -0.71至-0.36;p=0.0022; I2=0%），在仅限于第24周的敏感性分析中结果一致。两组患者临床反应（RR 1.94; 95% CI 0.57 ~ 6.56; p=0.1453; I2=23.7%）和肠内自主性（RR 4.21; 95% CI 0.00 ~ 280351.17; p=0.3479; I2=0%）差异无统计学意义。临床缓解的定义是在第20周和第24周内，每周PS量比基线减少≥20%。GLP-2类似物降低PS≥1天/周的频率更高（RR 2.27; 95% CI 1.59至3.26;p=0.0219; I2=0%）。结论：这项包含283例患者的4项随机对照试验的荟萃分析显示，与安慰剂相比，GLP-2类似物显著降低了每周PS量，并且更经常达到≥1天/周的PS减少，在肠内自主性或临床反应方面没有显著差异。
{"title":"GLP-2 analogues in short bowel syndrome: A systematic review and meta-analysis of randomized controlled trials","authors":"Pedro Batista Castro , Heitor Soares Brandão , Glauco Martins de Araujo , Gustavo Procópio Silva , Luísa Gonçalves Carvalho , Palle Bekker Jeppesen , Samuel I. dos Santos Pereira","doi":"10.1016/j.clnesp.2025.102881","DOIUrl":"10.1016/j.clnesp.2025.102881","url":null,"abstract":"<div><h3>Background & aims</h3><div>The efficacy of glucagon-like peptide-2 (GLP-2) analogues in patients with short bowel syndrome (SBS) with intestinal failure (IF) is not well established. We aimed to compare the efficacy of GLP-2 analogues relative to placebo in patients with SBS dependent on parenteral support (PS).</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Cochrane Central were searched from inception to April 15, 2025 for randomized controlled trials (RCTs) comparing GLP-2 analogues with placebo in patients with SBS. Endpoints included change in weekly PS volume, clinical response, enteral autonomy, and ≥1-day/week PS reduction. Pooled risk ratios (RRs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models. SMD was used due to differences in reporting units (mL/day vs. L/week).</div></div><div><h3>Results</h3><div>We included 283 patients from 4 RCTs, including one crossover trial; 188 (66.4%) received GLP-2 analogues. Weekly absolute PS volume reduction was significantly greater with GLP-2 analogues than with placebo (SMD −0.54; 95% CI −0.71 to −0.36; p = 0.0022; I<sup>2</sup> = 0%), with consistent results in a sensitivity analysis restricted to week 24. There were no significant differences in clinical response (RR 1.94; 95% CI 0.57 to 6.56; p = 0.1453; I<sup>2</sup> = 23.7%) and enteral autonomy (RR 4.21; 95% CI 0.00 to 280351.17; p = 0.3479; I<sup>2</sup> = 0%) between groups. Clinical response was defined as achieving a ≥20% reduction in weekly PS volume from baseline sustained through weeks 20 and 24. Reduction in PS by ≥ 1 day/week was more frequent with GLP-2 analogues (RR 2.27; 95% CI 1.59 to 3.26; p = 0.0219; I<sup>2</sup> = 0%).</div></div><div><h3>Conclusion</h3><div>This meta-analysis of 4 RCTs including 283 patients showed that GLP-2 analogues significantly reduced weekly PS volume and more often achieved ≥1-day/week reductions in PS compared with placebo, with no significant differences in enteral autonomy or clinical response.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102881"},"PeriodicalIF":2.6,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.clnesp.2025.102885
Tomáš Bolek , Petra Turňová , Svetlana Janošova , Martin Jozef Péč , Ivana Ságová , Norbert Nagy , Jakub Jurica , Marián Mokáň , Matej Samoš
Background and aims
Polycystic ovary syndrome (PCOS) and obesity increase the risk of infertility, preterm birth and birth of a hypertrophic neonate. Effective weight loss can improve this disorder. The aim of this study was to evaluate the effect of subcutaneous semaglutide in combination with metformin for the treatment of PCOS patients with obesity and prediabetes.
Patients and methods
We prospectively enrolled 20 consecutive PCOS patients with obesity and prediabetes, (mean age 32 years) with BMI 34.8 ± 4.3 kg/m2, on combination therapy with metformin 1000 mg daily and subcutaneous semaglutide 0.25–0.5 mg weekly. Patients were followed up for 6 months. All patients were clinically examined and human body composition (lean mass, fat) as well as weight were measured by bioelectrical impedance analysis InBody 370.
Results
There was a significant weight reduction after 5 months of therapy (98.4 ± 15.5 vs. 85.5 ± 16.6 kg, p < 0.05), and a reduction was observed in BMI (34.8 ± 4.3 vs. 30.2 ± 4.7 kg/m2, p < 0.05). Similarly, there was also a significant reduction of fat mass (41.3 ± 10.8 vs. 32.3 ± 10.3, p < 0.05), but no impact of therapy on lean mass (31.1 ± 4.5 vs. 29.1 ± 5.1 kg, p = 0.56). Within the follow-up period, a significant improvement in fertility was observed, with 60 % of the patients treated achieving pregnancy. All resulting pregnancies culminated in the delivery of eutrophic neonates.
Conclusion
In this study, we demonstrated a significant efficacy of combined treatment with subcutaneous semaglutide and metformin in effective weight reduction and improving fertility in patients with obesity, prediabetes and PCOS.
{"title":"Effect of semaglutide with metformin for weight loss and fertility in polycystic ovary syndrome (PCOS) patients with obesity: A pilot prospective study","authors":"Tomáš Bolek , Petra Turňová , Svetlana Janošova , Martin Jozef Péč , Ivana Ságová , Norbert Nagy , Jakub Jurica , Marián Mokáň , Matej Samoš","doi":"10.1016/j.clnesp.2025.102885","DOIUrl":"10.1016/j.clnesp.2025.102885","url":null,"abstract":"<div><h3>Background and aims</h3><div>Polycystic ovary syndrome (PCOS) and obesity increase the risk of infertility, preterm birth and birth of a hypertrophic neonate. Effective weight loss can improve this disorder. The aim of this study was to evaluate the effect of subcutaneous semaglutide in combination with metformin for the treatment of PCOS patients with obesity and prediabetes.</div></div><div><h3>Patients and methods</h3><div>We prospectively enrolled 20 consecutive PCOS patients with obesity and prediabetes, (mean age 32 years) with BMI 34.8 ± 4.3 kg/m2, on combination therapy with metformin 1000 mg daily and subcutaneous semaglutide 0.25–0.5 mg weekly. Patients were followed up for 6 months. All patients were clinically examined and human body composition (lean mass, fat) as well as weight were measured by bioelectrical impedance analysis InBody 370.</div></div><div><h3>Results</h3><div>There was a significant weight reduction after 5 months of therapy (98.4 ± 15.5 vs. 85.5 ± 16.6 kg, p < 0.05), and a reduction was observed in BMI (34.8 ± 4.3 vs. 30.2 ± 4.7 kg/m2, p < 0.05). Similarly, there was also a significant reduction of fat mass (41.3 ± 10.8 vs. 32.3 ± 10.3, p < 0.05), but no impact of therapy on lean mass (31.1 ± 4.5 vs. 29.1 ± 5.1 kg, p = 0.56). Within the follow-up period, a significant improvement in fertility was observed, with 60 % of the patients treated achieving pregnancy. All resulting pregnancies culminated in the delivery of eutrophic neonates.</div></div><div><h3>Conclusion</h3><div>In this study, we demonstrated a significant efficacy of combined treatment with subcutaneous semaglutide and metformin in effective weight reduction and improving fertility in patients with obesity, prediabetes and PCOS.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102885"},"PeriodicalIF":2.6,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.clnesp.2025.102884
Tatsuma Sakaguchi , Keisuke Maeda , Yuria Ishida , Mika Tsuchida , Koki Kawamura , Kaori Ohshita , Koji Amano , Naoharu Mori
Background & aims
Nutritional deterioration is highly prevalent in patients with advanced cancer, yet the diagnostic overlap and combined prognostic value of cachexia and malnutrition criteria remain unclear. This study aimed to investigate the consistency between the Asian Working Group for Cachexia (AWGC) and Global Leadership Initiative on Malnutrition (GLIM) criteria and their associations with overall survival (OS) in palliative care settings.
Methods
This retrospective cohort study included adult patients with advanced cancer referred to the palliative care team at Aichi Medical University Hospital between April 2019 and March 2024. Cachexia and malnutrition were diagnosed according to the AWGC and GLIM frameworks, incorporating both phenotypic and etiologic components. Patients were categorized into four groups based on diagnosis status: Group A (both cachexia and malnutrition), Group B (cachexia only), Group C (malnutrition only), and Group D (neither condition). OS was compared across groups using Kaplan–Meier analysis and Cox proportional hazards models adjusted for clinical covariates.
Results
Among 1325 eligible patients, cachexia and malnutrition were diagnosed in 76 % and 71 %, respectively, with a 65 % diagnostic overlap. Group A demonstrated the shortest median survival time (MST) at 74 days compared to 431 days in Group D (p < 0.0001). In multivariate analysis, only Group A diagnosis independently predicted poorer OS (hazard ratio [HR] 1.33, p < 0.001). Survival differences among Groups B, C, and D became evident only after excluding patients with edema (p = 0.008).
Conclusion
Complementary application of the AWGC and GLIM criteria enhances prognostic stratification in patients with advanced cancer. Careful evaluation of fluid status is essential to optimize nutritional assessment and outcome prediction in this population.
背景与目的：营养恶化在晚期癌症患者中非常普遍，但恶病质和营养不良标准的诊断重叠和综合预后价值尚不清楚。本研究旨在调查亚洲恶病质工作组（AWGC）和全球营养不良领导倡议（GLIM）标准之间的一致性，以及它们与姑息治疗环境中总生存率（OS）的关系。方法：本回顾性队列研究纳入2019年4月至2024年3月期间在爱知医科大学附属医院姑息治疗团队转诊的成年晚期癌症患者。根据AWGC和GLIM框架，结合表型和病因成分，诊断恶病质和营养不良。根据诊断情况将患者分为四组：A组（同时有恶病质和营养不良）、B组（仅有恶病质）、C组（仅有营养不良）和D组（两种情况均无）。采用Kaplan-Meier分析和Cox比例风险模型对临床协变量进行校正，比较各组间OS。结果：在1325例符合条件的患者中，恶病质和营养不良的诊断率分别为76%和71%，诊断重叠率为65%。A组的中位生存时间（MST）最短，为74天，而D组为431天（p < 0.0001）。在多变量分析中，只有A组诊断独立预测较差的OS（风险比[HR] 1.33, p < 0.001）。排除水肿患者后，B组、C组和D组的生存差异才显现出来（p = 0.008）。结论：AWGC与GLIM标准的互补应用可增强晚期肿瘤患者的预后分层。仔细评估体液状态对于优化这一人群的营养评估和预后预测至关重要。
{"title":"Complementary use of cachexia and malnutrition criteria improves prognostic stratification in patients with advanced cancer receiving palliative care","authors":"Tatsuma Sakaguchi , Keisuke Maeda , Yuria Ishida , Mika Tsuchida , Koki Kawamura , Kaori Ohshita , Koji Amano , Naoharu Mori","doi":"10.1016/j.clnesp.2025.102884","DOIUrl":"10.1016/j.clnesp.2025.102884","url":null,"abstract":"<div><h3>Background & aims</h3><div>Nutritional deterioration is highly prevalent in patients with advanced cancer, yet the diagnostic overlap and combined prognostic value of cachexia and malnutrition criteria remain unclear. This study aimed to investigate the consistency between the Asian Working Group for Cachexia (AWGC) and Global Leadership Initiative on Malnutrition (GLIM) criteria and their associations with overall survival (OS) in palliative care settings.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adult patients with advanced cancer referred to the palliative care team at Aichi Medical University Hospital between April 2019 and March 2024. Cachexia and malnutrition were diagnosed according to the AWGC and GLIM frameworks, incorporating both phenotypic and etiologic components. Patients were categorized into four groups based on diagnosis status: Group A (both cachexia and malnutrition), Group B (cachexia only), Group C (malnutrition only), and Group D (neither condition). OS was compared across groups using Kaplan–Meier analysis and Cox proportional hazards models adjusted for clinical covariates.</div></div><div><h3>Results</h3><div>Among 1325 eligible patients, cachexia and malnutrition were diagnosed in 76 % and 71 %, respectively, with a 65 % diagnostic overlap. Group A demonstrated the shortest median survival time (MST) at 74 days compared to 431 days in Group D (p < 0.0001). In multivariate analysis, only Group A diagnosis independently predicted poorer OS (hazard ratio [HR] 1.33, p < 0.001). Survival differences among Groups B, C, and D became evident only after excluding patients with edema (p = 0.008).</div></div><div><h3>Conclusion</h3><div>Complementary application of the AWGC and GLIM criteria enhances prognostic stratification in patients with advanced cancer. Careful evaluation of fluid status is essential to optimize nutritional assessment and outcome prediction in this population.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102884"},"PeriodicalIF":2.6,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.clnesp.2025.102847
Diana Studerus , Anne Roland Lee , Tabea Hugo , Philippe Heim , Jacqueline Jossen , Michael Scharl , Jonas Zeitz
Introduction
Maintaining a gluten-free diet (GFD) requires avoiding gluten containing grains, and preventing cross-contact with gluten-containing foods. Concerns about cross-contaminations can restrict food choices and may lead to behaviors resembling disordered eating. While guidelines state that gluten cross-contamination should be avoided, previous reviews and meta-analyses focused on whether contamination occurs, rather than its extent. Understanding contamination levels is crucial for risk assessment, resulting in a balanced approach that supports GFD adherence without hypervigilance or maladaptive eating behaviors.
Methods
A scoping review methodology was conducted across databases including MEDLINE, EMBASE, Scopus and Web of Science databases. Studies with real-life gluten contamination data were included. The protocol was registered on the Open Science Framework (https://osf.io/nhq84) and follows PRISMA-ScR guidelines.
Results
From 4044 screened studies, 59 met the inclusion criteria (1993–2024, 28 countries). The analysis identified 27,806 food samples, predominantly analyzed by sandwich ELISA R5. Of these, 3100 (11 %) had a gluten content exceeding 20 mg/kg, 359 samples (1.3 %) contained >80 mg/kg, and 142 samples (0.51 %) > 200 mg/kg. After excluding two potentially biased studies, conservative descriptive analysis of 15,467 samples revealed that 20 % of analyzed samples showed contamination >20 mg/kg (crude pooling). Oats showed the highest average cross-contamination and variability, while restaurant meals demonstrated the greatest inconsistency. We identified research gaps and inconsistent terminology use, leading us to propose a standardized definition of “cross-contamination.”
Discussion
Cross-contact occurs in approximately 20 % of samples, but clinically relevant levels (>200 mg/kg) are rare (0.9 %). Regular portions (100–300 g) of foods >200 mg/kg could exceed the 10 mg/day safety threshold. Our findings suggest strict avoidance of all cross-contact could be reconsidered. A nuanced approach discussing relevant sources while identifying clinically irrelevant ones could prevent maladaptive eating behaviors without compromising safety.
{"title":"Understanding cross-contamination in a gluten-free diet: A scoping review","authors":"Diana Studerus , Anne Roland Lee , Tabea Hugo , Philippe Heim , Jacqueline Jossen , Michael Scharl , Jonas Zeitz","doi":"10.1016/j.clnesp.2025.102847","DOIUrl":"10.1016/j.clnesp.2025.102847","url":null,"abstract":"<div><h3>Introduction</h3><div>Maintaining a gluten-free diet (GFD) requires avoiding gluten containing grains, and preventing cross-contact with gluten-containing foods. Concerns about cross-contaminations can restrict food choices and may lead to behaviors resembling disordered eating. While guidelines state that gluten cross-contamination should be avoided, previous reviews and meta-analyses focused on whether contamination occurs, rather than its extent. Understanding contamination levels is crucial for risk assessment, resulting in a balanced approach that supports GFD adherence without hypervigilance or maladaptive eating behaviors.</div></div><div><h3>Methods</h3><div>A scoping review methodology was conducted across databases including MEDLINE, EMBASE, Scopus and Web of Science databases. Studies with real-life gluten contamination data were included. The protocol was registered on the Open Science Framework (<span><span>https://osf.io/nhq84</span><svg><path></path></svg></span>) and follows PRISMA-ScR guidelines.</div></div><div><h3>Results</h3><div>From 4044 screened studies, 59 met the inclusion criteria (1993–2024, 28 countries). The analysis identified 27,806 food samples, predominantly analyzed by sandwich ELISA R5. Of these, 3100 (11 %) had a gluten content exceeding 20 mg/kg, 359 samples (1.3 %) contained >80 mg/kg, and 142 samples (0.51 %) > 200 mg/kg. After excluding two potentially biased studies, conservative descriptive analysis of 15,467 samples revealed that 20 % of analyzed samples showed contamination >20 mg/kg (crude pooling). Oats showed the highest average cross-contamination and variability, while restaurant meals demonstrated the greatest inconsistency. We identified research gaps and inconsistent terminology use, leading us to propose a standardized definition of “cross-contamination.”</div></div><div><h3>Discussion</h3><div>Cross-contact occurs in approximately 20 % of samples, but clinically relevant levels (>200 mg/kg) are rare (0.9 %). Regular portions (100–300 g) of foods >200 mg/kg could exceed the 10 mg/day safety threshold. Our findings suggest strict avoidance of all cross-contact could be reconsidered. A nuanced approach discussing relevant sources while identifying clinically irrelevant ones could prevent maladaptive eating behaviors without compromising safety.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102847"},"PeriodicalIF":2.6,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.clnesp.2025.102879
Camilla Wibrand, Anne Gaml-Sørensen, Anne Ahrendt Bjerregaard, Cecilia Ramlau-Hansen
{"title":"Reply - Letter to the editor.","authors":"Camilla Wibrand, Anne Gaml-Sørensen, Anne Ahrendt Bjerregaard, Cecilia Ramlau-Hansen","doi":"10.1016/j.clnesp.2025.102879","DOIUrl":"10.1016/j.clnesp.2025.102879","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":"102879"},"PeriodicalIF":2.6,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.clnesp.2025.102849
Vanessa Quan , Sharon Carey
Background
Functional constipation is one of the most prevalent disorders of gut-brain interaction, but available dietary interventions haven't been comprehensively collated.
Aims
The aim of this scoping review was to synthesise the current evidence surrounding dietary-based interventions used to manage functional constipation in adults and to identify any gaps among published dietary management strategies that could warrant further research, namely a systematic review.
Methods
A comprehensive database search was conducted on MEDLINE, CINAHL and Web of Science capturing the notions of ‘dietary management’ and ‘disorders of gut-brain interaction’, from which two rounds of screening were performed.
Results
Forty primary studies and twelve review papers were included in this review. These 52 papers non-exclusively cover a range of dietary domains including fibre supplementation (n = 15), microbiome modulation using prebiotics, probiotics or synbiotics (n = 26), functional foods (n = 10), fluid intake (n = 6) and other dietary approaches (n = 7). Fiber supplementation with psyllium is the current strongest dietary recommendation, with emerging strong evidence backing functional fruits like kiwifruit and prunes. Meanwhile the efficacy for all other approaches cannot be accurately deduced due to limited well-designed studies or conflicting evidence. However, improvements to constipation severity or symptoms have been observed with probiotics with both Bifidobacterium and Lactobacillus components, galacto-oligosaccharides, partially hydrolysed guar gum and various synbiotic formulations.
Conclusions
This paper contributes to the growing research around functional constipation where the open-ended approach allowed for identification and synthesis of all nutrition strategies trialed in the literature. We recommend further studies to be conducted on prebiotics, probiotics and synbiotics to determine its potential role in constipation management for this cohort.
背景：功能性便秘是肠脑相互作用最常见的疾病之一，但可用的饮食干预尚未得到全面整理。目的：本综述的目的是综合目前有关以饮食为基础的干预措施用于管理成人功能性便秘的证据，并确定已发表的饮食管理策略之间的任何差距，这些差异可能需要进一步的研究，即系统综述。方法：在MEDLINE、CINAHL和Web of Science上进行全面的数据库检索，获取“饮食管理”和“肠脑相互作用紊乱”的概念，从中进行两轮筛选。结果：本综述纳入了40项初步研究和12篇综述。这52篇论文涵盖了一系列饮食领域，包括纤维补充（n=15），使用益生元、益生菌或合成菌调节微生物组（n=26），功能性食品（n=10），液体摄入（n=6）和其他饮食方法（n=7）。用车前草补充纤维是目前最强烈的饮食建议，越来越多的有力证据支持猕猴桃和西梅等功能性水果。同时，由于有限的精心设计的研究或相互矛盾的证据，无法准确推断所有其他方法的疗效。然而，已观察到含有双歧杆菌和乳杆菌成分、半乳糖低聚糖、部分水解瓜尔胶和各种合成制剂的益生菌可改善便秘的严重程度或症状。结论：本文有助于围绕功能性便秘的研究，其中开放式方法允许识别和综合文献中试验的所有营养策略。我们建议对益生元、益生菌和合成菌进行进一步的研究，以确定其在便秘治疗中的潜在作用。
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Pub Date : 2025-12-11DOI: 10.1016/j.clnesp.2025.102845
Alyssa V. Ramuscak , Inez Martincevic , Jessie M. Hulst
Background & aims
Blenderized tube feeding (BTF) is the use of blended whole foods and liquids given into the gastrointestinal (GI) system via an enteral access device, such as a gastrostomy tube. With an increased interest among caregivers as well as clinicians in BTFs, variations have evolved including homemade BTFs (HBTFs), commercially prepared BTFs (CBTFs), and commercial food-based formula (CFBF). Convenient, ready-to-use alternatives to HBTFs, either CBTFs or CFBFs, are considered appealing by tube-fed patients and/or their caregivers, as well as health care providers. While CBTFs or CFBFs may offer similar benefits to HBTFs, research on these products has been sparse. This scoping review aims to map and summarize the currently available literature on CBTFs, CFBFs, or commercially blenderized feeds (CBFs) when undifferentiated in the study, as well as offer recommendations for clinical practice and future research.
Methods
This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A comprehensive search strategy was developed and applied across four databases: PubMed, Ovid MEDLINE(R), CINAHL, and Web of Science. Eligible studies were full-text, English language, articles that reported on the use of CBFs among the pediatric population receiving enteral nutrition.
Results
Sixteen studies met the inclusion criteria. Key outcome themes identified included clinical outcomes (GI symptoms, stool patterns, growth and weight, GI microbiome, and emergency department visits and hospitalizations), nutritional adequacy, satisfaction and quality of life, and viscosity and the effects of the administration of CBFs.
Conclusions
Current evidence suggests that CBFs may improve GI tolerance, support greater gut microdiversity, reduce medical burdens, and enhance quality of life in pediatric patients receiving enteral nutrition. Nevertheless, the limited number and methodological heterogeneity of studies highlight the need for more rigorous research to determine the long-term safety, efficacy, and nutritional adequacy of these formulas.
背景与目的：混合管饲（BTF）是使用混合的全食物和液体通过肠内通路装置，如胃造口管给予胃肠道（GI）系统。随着护理人员和临床医生对btf的兴趣日益增加，各种变体已经演变，包括自制btf (hbtf)，商业制备的btf （cbtf）和商业食品配方（CFBF）。管饲患者和/或其护理人员以及卫生保健提供者认为，方便、即用的HBTFs替代品（CBTFs或CFBFs）具有吸引力。虽然cbtf或cfbf可能提供与hbtf相似的益处，但对这些产品的研究很少。本综述旨在绘制和总结研究中未分化的cbtf、cfbf或商业混合饲料（CBFs）的现有文献，并为临床实践和未来研究提供建议。方法：本范围评价按照系统评价和荟萃分析范围评价扩展首选报告项目（PRISMA-ScR）进行。一个全面的搜索策略被开发并应用于四个数据库：PubMed， Ovid MEDLINE(R)， CINAHL和Web of Science。符合条件的研究是关于在接受肠内营养的儿科人群中使用cbf的全文、英文文章。结果：16项研究符合纳入标准。确定的关键结局主题包括临床结局（胃肠道症状、粪便模式、生长和体重、胃肠道微生物组、急诊科就诊和住院情况）、营养充足性、满意度和生活质量、粘度和给药CBFs的效果。结论：目前的证据表明，CBFs可以改善胃肠道耐受性，支持更大的肠道微生物多样性，减轻医疗负担，并提高接受肠内营养的儿科患者的生活质量。然而，研究的数量有限和方法的异质性突出了需要更严格的研究来确定这些配方的长期安全性、有效性和营养充分性。
{"title":"A scoping review of the clinical outcomes and use of blenderized tube feeds and commercial food-based formulas in pediatrics","authors":"Alyssa V. Ramuscak , Inez Martincevic , Jessie M. Hulst","doi":"10.1016/j.clnesp.2025.102845","DOIUrl":"10.1016/j.clnesp.2025.102845","url":null,"abstract":"<div><h3>Background & aims</h3><div>Blenderized tube feeding (BTF) is the use of blended whole foods and liquids given into the gastrointestinal (GI) system via an enteral access device, such as a gastrostomy tube. With an increased interest among caregivers as well as clinicians in BTFs, variations have evolved including homemade BTFs (HBTFs), commercially prepared BTFs (CBTFs), and commercial food-based formula (CFBF). Convenient, ready-to-use alternatives to HBTFs, either CBTFs or CFBFs, are considered appealing by tube-fed patients and/or their caregivers, as well as health care providers. While CBTFs or CFBFs may offer similar benefits to HBTFs, research on these products has been sparse. This scoping review aims to map and summarize the currently available literature on CBTFs, CFBFs, or commercially blenderized feeds (CBFs) when undifferentiated in the study, as well as offer recommendations for clinical practice and future research.</div></div><div><h3>Methods</h3><div>This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A comprehensive search strategy was developed and applied across four databases: PubMed, Ovid MEDLINE(R), CINAHL, and Web of Science. Eligible studies were full-text, English language, articles that reported on the use of CBFs among the pediatric population receiving enteral nutrition.</div></div><div><h3>Results</h3><div>Sixteen studies met the inclusion criteria. Key outcome themes identified included clinical outcomes (GI symptoms, stool patterns, growth and weight, GI microbiome, and emergency department visits and hospitalizations), nutritional adequacy, satisfaction and quality of life, and viscosity and the effects of the administration of CBFs.</div></div><div><h3>Conclusions</h3><div>Current evidence suggests that CBFs may improve GI tolerance, support greater gut microdiversity, reduce medical burdens, and enhance quality of life in pediatric patients receiving enteral nutrition. Nevertheless, the limited number and methodological heterogeneity of studies highlight the need for more rigorous research to determine the long-term safety, efficacy, and nutritional adequacy of these formulas.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102845"},"PeriodicalIF":2.6,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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